Individual
LATRELL LATRESS JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LLBSW
Contact information
Practice address
35425 W MICHIGAN AVE, WAYNE, MI 48184-9800
(734) 722-4091
Mailing address
26875 PARKSIDE DR, TAYLOR, MI 48180-7556
(313) 465-5307
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
6802089266
MI
Other
Enumeration date
03/09/2020
Last updated
03/09/2020
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